L.A. County Plan to Ease Obstetric System Chaos : Medi-Cal: Private hospitals would be paid directly for services as part of proposal to ease overcrowding.

In a novel program, Los Angeles County health officials have joined forces with the private sector in a plan to divert thousands of pregnant women to private hospitals to ease the tremendous overcrowding of the county’s obstetrical system.

In exchange, the county has offered to cut Medi-Cal red tape for private hospitals and doctors by paying them directly for their services, then claiming reimbursement from the state under Medi-Cal guidelines. The plan also offers the incentives of filling empty obstetrical beds at some of the private hospitals, and of bringing some order to the current chaos in obstetrics.

So far, 21 private hospitals--which collectively can provide about 300 additional obstetrical spaces per month--have agreed to participate. If all goes well, officials say the plan could be implemented within two months.

Virtually every hospital, public and private, is struggling with the problem of women showing up in labor in their emergency rooms without a doctor or any record of prenatal care. Overcrowding in the county health-care system--from neighborhood health centers to the county’s five hospitals with obstetrical services--is largely to blame.

Things were so bad one Saturday last month at the county’s Harbor-UCLA Medical Center in Torrance that an exhausted staff obstetrician simply stopped admitting patients, even as they arrived at the hospital in labor. Instead, he handed them road maps, saying they would be better off delivering their babies elsewhere. Private hospitals in the area were marked on the maps.

Embarrassed hospital administrators quickly declared the doctor’s actions to be contrary to policy, and said no such diversion of patients would be attempted again, no matter how busy things were in the obstetrical unit.

But Dr. Charles Brinkman, Harbor-UCLA’s chief of obstetrics, will not guarantee that is possible.

“It is a judgment about whether the conditions are safe,” he said. “We are running at 130% above our designed capacity. We are staffed for 17 deliveries a day and are routinely hitting 25 to 35 a day. . . . The staff here are heroes in my eyes, and I am really upset that the community hasn’t helped us out.”

The plan being formulated is just such a community effort, which is what makes it unique, local officials and the American Hospital Assn. say. Besides the county Department of Public Health, the major players are the Los Angeles County Medical Assn. and the Hospital Council of Southern California.

“We saw the crisis coming. We can see very clearly that the county is over capacity,” said David Langness, the council’s vice president for community relations. “What we are attempting to do is apportion out the overflow births from the county system to the private hospitals that are willing and able to deliver.”

The plan has two goals: to provide for the orderly use of existing hospital facilities for deliveries and to get women into care early in their pregnancies so they and their babies have the best chance.

For the program to work, planners say, staff doctors at these hospitals must also be willing to participate. The medical association has given the health department the names of nearly 5,000 private obstetricians, pediatricians, anesthesiologists and family practitioners, all specialists involved at some point in the care of pregnant women and the safe delivery of their babies.

The county mailed contracts to the doctors on the association’s list earlier this month, accompanied by a letter of endorsement from medical association President David Chernof. It is still too early to predict how many will sign up, he said.

Meanwhile, county health officials are negotiating with Medi-Cal authorities for approval of the plan’s financial aspects. Both sides say agreement is near.

Early prenatal care has not been an option for many poor women in Los Angeles County, particularly as the public health care system has seen its funding reduced while the number of people depending upon it for care has increased. The burden in obstetrics is especially acute because few private obstetricians are willing to accept Medi-Cal insured patients. This is a major factor in the current imbalance, with five county hospitals handling a crushing load of the county’s 190,000 annual births while obstetrical units in some private hospitals have empty beds.

Too much paperwork, slow reimbursement and outright refusal of claims are the reasons most cited by doctors and hospitals for washing their hands of Medi-Cal--and the poor patients it serves. Last June, Medi-Cal stopped paying its bills altogether because of legislative delay on a supplemental appropriation. The program resumed payments in July, but the incident was yet another black mark on a record that already made the program a tough sell to health-care providers.

There is a hitch, though. Medi-Cal requires hospitals receiving its money to offer a full range of care to publicly insured patients, not only single services such as obstetrics. Of the 130 hospitals in Los Angeles County, 70 have Medi-Cal contracts, not enough to make the obstetrical program work.

(In San Diego County, the obstetrical care issues are different, because most hospitals here do have Medi-Cal contracts, said Linda Bethel, project coordinator for the Perinatal Access Project, set up last year by the American College of Obstetricians and Gynecologists.

(Consequently, the main problem isn’t getting the deliveries done, but trying to assure that women get prenatal care so they don’t show up in emergency rooms at all, she said.

(Bethel has been involved in discussions in which the county is trying to find a way to make it more attractive for obstetricians to care for patients. The proposal would have the county assume some of the responsibility for billing and other red tape of caring for Medi-Cal patients.)

Few outside the system want to join, but a good number of these are willing to help out in a limited fashion in the obstetrics area, according to Langness.

Methodist Hospital of Southern California in Arcadia is one. Its president, Frederick C. Meyer, said the pressure to join the obstetrical safety net came from doctors on the staff who knew of the “terrible overcrowding” at nearby County-USC Medical Center.

When the Hospital Council of Southern California pitched the cooperative plan, he readily signed up.

The county medical association’s Chernof, who has brought single-minded enthusiasm to the project, confesses to some dismay at how long it has taken to put the plan together. His involvement began last September. He worries that the incident at Harbor-UCLA, however unsanctioned, may scare hospitals and doctors who might otherwise participate in the program.